Kinder, gentler diagnosis of Primary Aldosteronism (PA)

Not content with drawing attention to the condition and improving its treatment, the people behind Hudson Institute’s Primary Aldosteronism Centre of Excellence (PACE) have now identified a faster, gentler way of identifying its cause.

Primary Aldosteronism (PA) is an underdiagnosed cause of hypertension, resulting from excess aldosterone production by the adrenal glands. Without treatment, people with PA have an increased risk of stroke, heart attack at a younger age, arhythmias and in some cases, heart and kidney failure.

However, successfully treating PA depends on establishing which of its two main causes is responsible, and until now, that has involved an invasive procedure known as AVS (Adrenal Vein Sampling).

Endocrinologist and PhD Student, Dr Elisabeth Ng, says AVS is uncomfortable, expensive and limited in availability, so a better alternative is needed.

Non-invasive alternative for PA diagnosis

That alternative came in the form of a non-invasive nuclear imaging scan called [68Ga]Ga-Pentixafor PET/CT.

“Patients with PA currently face an invasive procedure (AVS) to determine if their high blood pressure and increased risk of cardio-metabolic disease caused by PA can be addressed by surgery,” Dr Ng said.

“AVS requires patients to spend at least half a day in hospital, lie flat and still for the procedure which can take 1-3 hours, and have blood collected through a vein in the groin” she said. “It is often described as uncomfortable and time-consuming.”

“The PET scan investigated in this study is not invasive and it requires a lot less time spent in hospital. It is better tolerated and has a lower risk of side effects. Overall, it would mean a better experience for the patient.”

Dr Ng led a study with her PACE colleagues (Dr Jimmy Shen, Dr Ian Jong, Prof Peter Fuller, Prof Jun Yang) which evaluated both options. A cohort of adults with PA underwent both AVS and [68Ga]Ga-Pentixafor PET/CT to investigate the diagnostic accuracy of the PET scan and compare its performance to AVS as the gold standard.

Supervisor, Professor Jun Yang, a pioneer of PA diagnosis and treatment, said the results were very encouraging.

Preferred by patients

“Survey responses indicated that PET/CT was faster, better tolerated, and the preferred test by 97% of participants.” Prof Yang said.

She believes this study makes an important contribution to the current literature: “This is the first study of a PET tracer for PA subtyping in Australia, and unlike previous studies of [68Ga]Ga-Pentixafor PET/CT which have been conducted in Asian cohorts, we have tested the tracer in a multi-ethnic population.”